Gonioscopic angle evaluation and its correlation with graft survival and post-operative ocular hypertension in patients of Descemet’s stripping endothelial keratoplasty

Abstract

Purpose: To evaluate the gonioscopic changes in patients receiving Descemet’s stripping endothelial keratoplasty (DSEK) without pre-existing ocular hypertension (OHT) and to report its correlation with post-surgery OHT, graft survival, and visual outcomes. Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow-up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post-DSEK OHT details were documented. Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra-ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid-induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre-operative best corrected visual acuity was 1.62 logMAR (range 1.17–1.77), which gradually improved to 0.79 logMAR (range 0.3–1.77) after 2 years (p < 0.00001). Conclusion: PAS was found to be an important factor associated with post-DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.

Scheimpflug Corneal Tomography Anterior Chamber Depth in Descemet Stripping Endothelial Keratoplasty Recipients

“…It has previously been described that ocular hypertension and decreased graft survival have been associated to peripheral anterior synechiae seen by gonioscopic examination in post-DSEK eyes. 20 Similar inciting events leading to increased IOP are also described in postpenetrating keratoplasty eyes. 21 We believe that a prospective study where angle structure and anterior synechia are followed closely after DSEK surgery would provide better insight into this phenomenon of anterior chamber–shallowing DSEK.…”

Commentary: Ocular hypertension after Descemet’s stripping endothelial keratoplasty

“…The current article in the Indian Journal of Ophthalmology (IJO)[ 1 ] focuses on raised intraocular pressure (IOP) in eyes that did not have ocular hypertension (OHT) before EK. Formation of peripheral anterior synechiae (PAS) was contributory to raised IOP post-DSEK and needed trabeculectomy and goniosynechiolysis in four cases, which ultimately had graft failure.…”

Commentary: Idiopathic elevated episcleral venous pressure - Tension with twisted tortuousity

“…Therefore, engorged episcleral veins in a noninflamed eye with elevated IOP should prompt the clinician to consider this diagnosis and exclude other grave etiologies. [ 10 ]…”